The value of preoperative Glasgow Prognostic Score and the C-Reactive Protein to Albumin Ratio as prognostic factors for long-term survival in pathological T1N0 esophageal squamous cell carcinoma

Abstract

Plenty of studies have confirmed the prognostic values of inflammation-based prognostic scores in many malignant tumors. In present study, we aim to explore whether these indexes has same prognostic values in patients with stage T1N0 esophageal squamous cell carcinoma (ESCC). The clinicopathological data of 160 consecutive patients with pathological stage T1N0 ESCC from January 2005 to December 2012 were collected retrospectively. As prognostic factors, the inflammation-based prognostic scores, including C-reactive protein (CRP), Glasgow prognostic score (GPS), prognostic index (PI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and CRP to albumin ratio (CAR), were evaluated. The best cut-off values were determined by the receiver operating characteristic (ROC) curves. The median follow-up time was 71.8 months. During the follow-up period, 34 (21.3%) patients occurred postoperative recurrence and 30 (18.8%) tumor-related deaths were recorded. The best cut-off values of CRP, NLR, PLR and CAR were 1.090, 1.976, 103.200 and 0.023, respectively. After multivariate analysis, the GPS and CAR were identified as independently prognostic factors for overall survival (OS) (p=0.017 and 0.040, respectively). Of all 160 individuals, there were 86 (53.8%) and 85 (53.1%) patients classified into high GPS group (1-2) and elevated CAR group (>0.023), respectively. In addition, the GPS were positively associated with PI (p<0.000) and the levels of serum CRP (p<0.000), NLR (p=0.004), PLR (p=0.029) and CAR (p<0.000) and the above correlations were also observed between the CAR and other inflammation-based prognostic scores (all p<0.050, except for p=0.054 for PLR levels). The preoperative GPS and CAR were simple, inexpensive, readily available predictor for long-term survival in stage T1N0 ESCC patients who underwent esophagectomy.

C‐reactive protein/albumin ratio is a poor prognostic factor of esophagogastric junction and upper gastric cancer

“…Recently, Yu et al . explored the prognostic value of inflammation‐based prognostic scores, including the CRP, NLR, PLR, GPS, prognostic index, and CRP/Alb ratio in T1N0 esophageal squamous cell carcinoma and found that only GPS and CRP/Alb ratio were predictive of long‐term survival in multivariate analyses . In summary, most previous reports suggest that the prognostic ability of the CRP/Alb ratio could be comparable with that of GPS and superior to that of other inflammation‐based prognostic scores.…”

“…These biomarkers can be evaluated easily by sampling a small amount of peripheral blood. Prognostic significance has been gradually elucidated by accumulation of data from studies in gastrointestinal tumors such as esophageal cancer, gastric cancer, and colorectal cancer . However, few studies about the relationship between these biomarkers with respect to prognosis in patients with AEG have been published.…”

“…They demonstrated that its prognostic ability was comparable with that of modified GPS (mGPS) and better than that of NLR . Since then, the frequency of studies about the relationship between the CRP/Alb ratio and prognosis of malignant diseases is increasing . Liu et al .…”

“…The CONUT score was based on the serum Alb level, peripheral lymphocyte count, and total cholesterol level, as previously described . The CRP/Alb ratio was defined as the serum CRP level divided by the serum Alb level . Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff values of the NLR, PLR, GPS, CONUT score, and CRP/Alb ratio (Fig.…”

“…We previously reported that skeletal muscle loss was strongly associated with a poor long‐term prognosis in patients who underwent surgical treatment of AEG and UGC . Also, several common inflammation‐based prognostic scores, including the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), Glasgow Prognostic Score (GPS), and controlling nutritional status (CONUT) score have been reported to have prognostic value in patients with many types of malignant, solid tumors . The C‐reactive protein (CRP)/albumin (Alb) ratio has also been reported as a novel inflammation‐based prognostic marker in multiple types of tumors, including hepatocellular carcinoma, colorectal cancer, esophageal cancer, renal cancer, pancreatic cancer, and gastric cancer …”